Provider Demographics
NPI:1871640953
Name:WARREN, JARED SCOTT (PHD)
Entity type:Individual
Prefix:DR
First Name:JARED
Middle Name:SCOTT
Last Name:WARREN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1190 NORTH 900 EAST
Mailing Address - Street 2:291 JOHN TAYLOR BUILDING, BYU
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84602-8626
Mailing Address - Country:US
Mailing Address - Phone:801-422-5600
Mailing Address - Fax:801-422-0163
Practice Address - Street 1:1190 NORTH 900 EAST
Practice Address - Street 2:291 JOHN TAYLOR BUILDING, BYU
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84602-8626
Practice Address - Country:US
Practice Address - Phone:801-422-5600
Practice Address - Fax:801-422-0163
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5972170-2501103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent